A Qualitative Enquiry into the Tribal Mothers' Breastfeeding and Related Hygiene Practices in Kerala

Adequate and appropriate breastfeeding is critical to child survival, growth and development; however, there are widespread inconsistencies in breastfeeding practices with respect to its adequacy and appropriateness, especially in historically marginalize tribes in Kerala. Hence, this study explored breastfeeding and related hygiene practices of tribal mothers with children aged between 0 to 24 months. We conducted 10 FGDs to collect data from five districts with significant proportion of tribal populations in Kerala, using a qualitative descriptive approach to enquiry. Two groups of participants were selected. First group was biological mothers and the second group was grandmothers of children aged between 0-24 months. All FGD participants were purposively selected and thematic analysis was used for data analysis. Hospital delivery has reduced prelacteal feeding. Perceptions of inadequate breastmilk relate with delayed initiation of BF. BF is predominantly demand driven. Communal norms sanction long duration of breastfeeding and nearly all mothers knew EBF. Perceptions of perceptions of inadequate breastmilk relate with early initiated CF. BF benefits to children are in terms of health, cognition, emotional bonding and growth but are harmful for mothers' health and beauty. Mothers with poor family support face multiple rolerelated strains. Nearly all mothers have information of colostrum feeding and EBF for 0-6 months but EBF practice was suboptimal. Mothers enjoying poor family support face multiple role-related strains leading to suboptimal breastfeeding. The colostrum avoidance and prelacteal feeding was less frequent due to hospital deliveries but many believed that breastmilk alone was insufficient to newborns, leading to early CF. Proactive breastfeeding was less frequent and knowledge about breastfeeding benefits was child centric. Mothers' work and household chores conflict with breastfeeding frequency.